DIABETIC LEG ULCERS

Generally leg ulcers occur due to venous disease (50%), arterial disease (10%), mixed arterial venous disease (25%) and the remainder due to some unidentified causes. Bacterial infections, traumatic effects, chronic boils and surrounding small boils or eruptions, use of oral or local drugs etc may cause onset of ulcers. Such leg ulcers are more common in middle-aged persons. Apart from infection, diabetes is considered to be major causative. Such patients should always protect their feet and lower legs from injuries. They should not walk on foot (bare foot) , on rough and uneven grounds, come into contact with sharp instruments or be crushed by some machine vehicle or any other such object. When diabetes is under control such ulcers do show a declining trend, and heal also but any neglect may lead to amputation of the affected organ. Such ulcers must be cleaned, disinfected and dressed with an antiseptic agent, and well protected form hear, dust and frost bite. Extreme conditions of heat and cold can further complicate the problem. Care should be taken to ensure elimination of any precipitatory factors and antagonistic factors. Do not leave anything to chance.

Foot Ulcers: Similarly, foot ulcers also need to be attended to and treated without delay. Possibility of ulcers in the obese is a greater than others, especially if the obese are diabetics also. Dibeties foot, a common complication, can be easily inferred from pink skin, warmth, diminished sensation, painless ulceration, digital gangrene, callus formation, clawed toes, neuropathic oedema. If there is much and extensive tissue and, or boney destruction, amputation may be required and if so, it must not be delayed healing period I quite long, and during course of treatment even a NIDDM patient may have to be put on insulin and hypoglcaemic drugs to meet exigencies of the situation. Proper control is of paramount necessity if one wishes to promote healing or halt further infection.

Impotency: Impotency occurs in 25% of diabetic cases. It can be physical or mental or even both (psychosomatic impotency). Patient has strong sexual desire but his semen dribbles away as soon he gets sexually excited or even when he attempts to have coitus. This gives a sense of inferiority to such a person. The organ may be in erectile position, desire may also be intense but sexual act cannot be done. Hormonal changes can also be one of causes of diabetic impotency. So, endocrine gland factor should also be investigated. Sexual function is also affected by antihypertensive drugs like methyldopa & deta-adrencoceptor. Surgical interference is not equired in such cases.

Phimosis: This is one of the complications to which some patients are amenable of. Foreskin of glans penis gets thickened and thus cannot be drawn back. In paraphumosis, the skin can be drawn back though with some effort and pain, but retraction is difficult. In phimosis even passing of urine can pose problems. In such a case surgical resort is required, especially one can neither pass urine nor cohabitate. Both the complications need to be attended to and treated quickly.

Stomatitis: it means inflammation of whole of sub-mucous portion of the mouth when tongue and surrounding areas are purple red, with small eruptive pimples, when even slightly cold or warm water is also intolerable salt and spices further aggravate the trouble. Normal eating is also effected. The tongue is dry. These symptomatic symptoms often torment a diabetic. The cause is often attributed to malnutrition, including lack of vitamin b-complex. Sometimes even hot food and drinks, local applications and irritants cause stomatitis which is also indicative of poor healing and diet. Diabetic persons should ensure proper hygiene of their mouth, take plenty of green & leafy vegetables, having fibre. Riboflavin can cure this complication. Sine sore and swollen mouth is liable to affect process of digestion, hence it should be treated without any delay. All hot, pungent, irritating spicy things should be avoided. Rinse your mouth with mixed with boric acid after which pure glycerine may be applied. If neglected or allowed to prolong, it may turn into aphthuous stomatitis when superficial and painful ulcers may emerge. Cancer of the tongue or entire sub-mucous portion may also set in as a terminal manifestation.

Skin Infections : Skin of a diabetic is generally found to be dry and rough-may be due to diet factor, insufficient secretion from sebaceous glands and lack of water-content in the body. Dryness of hair and skin is a common complaint with diabetics. Their skin is more susceptible to changing weather conditions, effects of cosmetic applications, certain vegetations and the odour flowing therefrom, reactions due to oral and local, use of drugs, contact dermatitis, exposure to gas etc. skin infections are too numerous to be counted or mentioned. Best method is to keep it neat, clean and dry by using bland and non-irritating agents. Avoidance of immediate causes or precipitatory factors is a pre-emptive method. But, never delay, ignore, neglect any odd skin symptom. Perfect hygiene and regular care will spare the agony of many future complications.
Our purpose and intention is neither to scare the patient nor to crate and psychic phobia, but to enlighten, within the ambit of our competence, so that the ravages and complications, generally caused by this ‘silent killer’,are taken note of by the patient and his family members. If any disorder is detected and then treated in time, before it is late, much effort, money and agony of all concerned can be saved and damage avoided.
Patients in their interest, are advised not to delay or linger on the complications, instead they should, at once, get in touch with their doctors so that timely corrective/curative steps are taken. Every symptom and cure may be evasive and eluding in some complex cases. But, by proper education, guidance, motivation and monitoring most of the complications can be taken care of by the patients themselves, as the maxim goes to prove that ‘being forewarned is fore-armed.’ In fact, young ones, pregnant ladies and old persons should be more careful to infective disease along with diabetic complications though persons of other categories need not be, in any way, careless and complacent.